Oral or enteral nutritional supplementation in cirrhosis

A study published ahead of print in the Alimentary Pharmacology & Therapeutics reviews oral or enteral nutritional supplementation in cirrhosis.

Malnutrition is a common and clinically significant problem in patients with cirrhosis.

The impact of nutritional therapy remains unclear.

Dr Ney and colleagues reported that to provide an up-to-date systematic review and meta-analysis of randomized controlled trials of oral or enteral nutritional supplementation on nutritional and clinical outcomes in adult patients with cirrhosis.

The primary outcome measure was survival.

The research team assessed tfull-text English language randomized controlled trials investigating oral or enteral nutritional supplementation vs a standard nonsupplemented diet in patients with cirrhosis.

The team administered a parenteral or branched chain amino acids intervention, with a treatment duration of 7 days.

The researchers evaluated posttransplant, postsurgical or quality of life outcomes.

The doctors reported that 6 trials, and 470 patients were included with 71% males and median age 53 years.

When all studies were combined, there was no reduction in mortality.

The calculated pooled gastric cancer incidence-rate was about 0.3% per person-years

Alimentary Pharmacology & Therapeutics

The researchers noted that the subgroup analysis of 3 of the 4 oral nutrition supplementation studies did demonstrate a mortality reduction.

Of the 2 enteral nutrition supplementation studies, 1 included the sickest patients in the meta-analysis, and the other had the shortest mean intervention duration, possibly impacting the potential for benefit.

Study quality was suboptimal.

Dr Ney's team commented, "Although there is insufficient evidence to definitively state that oro-enteral nutritional supplementation impacts clinical outcomes, on the basis of this analysis, one can be cautiously optimistic that there is the potential for benefit without an increase in adverse events."

"Adequately powered, Child Pugh stratified studies of at least 1 month in duration are needed to clarify the impact on relevant clinical outcomes."